Breast screening in Canada, 2023-24

Follow-up after an abnormal mammogram

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Provinces and territories notify primary care providers, participants or both after an abnormal mammography result.

After an abnormal screening test, most jurisdictions notify participants either by phone or mail, but in some cases participants are notified by their PCP. The location for conducting diagnostic mammograms after an abnormal result varies across Canada. Some jurisdictions conduct diagnostic mammograms at the screening centre/program while others conduct mammograms at diagnostic imaging centres or refer participants to Breast Risk Assessment units.

Receiving results and follow-up for an abnormal breast screening test results

P/T Receive abnormal results Follow-up of abnormal results Location of diagnostic mammogram after abnormal result Guideline screening interval
YT Mailed to participant

Program may also contact participant by phone depending on the follow-up required (imaging)

 Program calls participant to arrange follow-up appointments for imaging

If biopsy required, participant must go back to their PCP for referral to biopsy or any other follow-up

 Whitehorse General Hospital (same as screening location) If follow-up results are normal, participants are recalled for screening every two years (or as recommended by radiologist)
NT Participants in the program receive a phone call, as well as a letter Program calls participant to arrange follow-up appointments for imaging

If biopsy required, participant must go back to their PCP for referral to biopsy

Program notifies PCP that a patient requires biopsy

 Stanton Territorial Hospital or a facility in Edmonton, Alberta If follow-up results are normal, participants are recalled for screening every two years (or as recommended by radiologist)
NU Varies by site; generally sent to PCP, who will contact participant to provide results PCP manages referrals for any follow-up required
BC Participant receives phone call from diagnostic centre to book follow-up

Results also sent to PCP and mailed to participant

 Diagnostic centre books follow-up and calls participant with appointments Affiliated diagnostic imaging departments If follow-up results are normal, participant are recalled for screening every one to two years per identified risk factor program policy
AB Most clinics notify PCPs and/or participant in person or by phone

Results also sent to PCP and mailed to the individual

 Clinic or PCP contacts participant to arrange follow-up

Some clinics book follow-up directly (varies by site)

 If mammogram was completed at a facility that can do diagnostic mammograms, then usually done at the same facility

Private clinics

Hospital facilities

 If follow-up results are normal, participants are recalled for screening every two years (or as recommended by radiologist)
SK Participants receive results by phone, either from program (navigator) or their PCP

Participants can look up results on their online health record. A letter will also be sent after navigation arranges follow-up appointment

 Program navigator arranges follow-up with an established medical directive; otherwise PCP will arrange follow-up

If program is conducting follow-up, they contact the participant to arrange appointments

PCP can also obtain radiologist report on electronic health record

 Diagnostic breast imaging centres (hospitals, private radiology clinics, and/or Breast Health Centres) If follow-up results are normal, individuals are recalled for screening every two years (or as recommended by radiologist)

Individuals who are diagnosed with cancer have the option to return to regular screening once they have been cancer-free for five years
MB Participants receive results by phone call from program

Results also sent to participants and their healthcare provider by letter

 Referral to diagnostic centre coordinated by program. Individual is advised of follow-up appointment by program (phone) Diagnostic imaging centre If follow-up results are normal, participants are recalled for screening every two years (or as recommended by radiologist)

All individuals are informed of their status (i.e., if they will be recalled for screening or are no longer eligible) by letter once diagnostic work-up is complete
ON Ontario Breast Screening Program (OBSP) sites are expected to ensure the participant’s PCP is informed of the abnormal breast screen results as soon as possible

Participants’ receipt of abnormal results varies by site: some may call, others send letters, and a few may liaise with the PCP who will contact participants to provide results

 Follow-up varies by site: some sites may coordinate appointments, and the PCP may coordinate follow-up at other sites

If participant does not have a PCP, the screening site will designate a PCP who will manage follow-up for the participant until diagnosis

 Program assessment sites (hospitals and independent health facilities) that conduct diagnostic imaging

Assessment sites outside of the program (hospitals and independent health facilities) that conduct diagnostic imaging

 If follow-up results are normal, most participants are recalled for screening every two years; however, some participants are recalled in one year based on identified risk factors and/or radiologist recommendation.
QC Mailed to participants

PCP or centre will contact participants to provide results

 Follow-up varies: participants are directed to contact site or PCP in their results letter, or some sites contact the person proactively to arrange follow-up Designated screening centres or reference and diagnostic designated centres If follow-up results are normal, participants are recalled for screening every two years (or as recommended by radiologist)
NB Most sites contact participants by phone Varies across sites; participants are typically referred automatically for diagnostic procedure Designated facilities (hospitals) offering diagnostic mammography services Participants with an abnormal mammogram but no cancer diagnosis can return to the screening program and be reinvited for screening with a physician or nurse practitioner’s recommendation
NS Mailed to participants

Results letters e-faxed to PCP three days before letter sent to individual, so that PCP can notify them of their abnormal results and follow-up appointment information

 Program schedules follow-up appointments per radiologist recommendation. Appointment information mailed to PCP and to participant in results letters

Booking process for needle core biopsy varies by site: some book as per radiologist recommendation (without requisition), others require requisition from PCP

 Diagnostic breast imaging departments located in hospitals If follow-up results are normal, then individuals are recalled for screening every two years (or yearly if recommended by radiologist)
PE Notification of follow-up imaging mailed to participant

Results letter mailed to PCP

 Notification for follow-up through abnormal results letter

Individual is contacted by phone the day prior to appointment

If biopsy is required, the PCP contacts the individual

 Screening program and diagnostics performed at same two hospital sites

Biopsy at one site only

 If follow-up results are normal, individuals are recalled for screening every two years (or as recommended by radiologist)
NL Mailed to participant

Results mailed to PCP two days before sent to participant

 Program coordinates follow-up testing appointments and sends to participants by mail, along with abnormal results

Appointment with PCP may be made but is not required

 Diagnostic breast imaging departments located in hospital If follow-up results are normal, individuals are recalled for screening every two years (or as recommended by radiologist or program protocol)

In the absence of a primary care provider, most jurisdictions assign or help participants find a suitable primary care provider to follow up after an abnormal mammography result. In jurisdictions where a PCP is not assigned, the program coordinates follow-up.

When participants cannot be reached (e.g., mail is returned), most provinces and territories contact their primary care provider or PCP assigned to them or obtain current contact information from the PCP.

Access to breast screening for participants who do not have a primary care provider or cannot be reached

P/T Process when participants do not have a PCP Process when participants cannot be reached
YT PCP Identified when booking the mammogram. Follow-up with PCP.
NT Participant must have a PCP to be screened. PCP is identified when booking the mammogram. A recent change entails that those who reside in Yellowknife and the Yellowknife catchment area do not require a PCP to be screened in the Yellowknife BSP. If participants in Yellowknife do not have a PCP, a default PCP will be assigned to the participant. A Yellowknife Breast Screening Program (YKBSP) program booking coordinator will contact the patient by telephone if further imaging is required. If it cannot be completed in Yellowknife, a letter is sent to inform the PCP, who is responsible for the referral. If letter is returned, the program will check electronic and hospital systems to confirm address and then call patient to confirm address with them.

Hay River Breast Screening Program (HRBSP) has no specific policy. Program coordinator will call the patient’s listed phone number if patient is from Hay River or Enterprise. If patient lives in an outlying community, a call is placed to the community health centre/PCP.
NU PCP identified based on jurisdiction where scan takes place.
BC Participants must have a PCP to be screened. They can also identify a walk-in clinic, naturopath, NP, or register with TELUS health app, and inquire about the local urgent and primary care centre to be attached. PCP identified at time of booking the mammogram. Follow-up with PCP.
AB PCP is usually identified when booking the mammogram. Program will assist participant with finding a PCP, either before the screen or after an abnormal result. Screen site will notify PCP.
SK Participant can attend screening. If screening result requires follow-up, a nurse navigator works with participant to find PCP. Follow-up for current contact information. A letter is sent to the participant to let them know the screening program is trying to reach them. Screening results are sent to a PCP if identified.
MB In the result of an abnormal result, program will assist participant in obtaining a PCP though the provincial Doctor Finder initiative.. If a PCP cannot be obtained, program medical lead will assume care of patient for follow-up testing. A result letter is mailed to the participant and their PCP (includes a notation that we have been unable to reach the participant by phone).
ON People ages 50-74 can self-refer to the OBSP if they do not have a primary care provider.*

If a participant with abnormal results or actionable incidental findings does not have a PCP, the screening site will designate a family doctor or nurse practitioner who will manage follow up for the participant until diagnosis.

 The program site will notify the PCP. Program site may also continue to call and/or send a letter to the participant, requesting that they follow-up with the site.
QC Voluntary program PCP is assigned to the participant to manage follow-up. Program coordinators contact participant or PCP 45 days (or less) after an abnormal screening test if no supplementary exam has been confirmed in the information system. If participant is still unreachable after 90 days, they will be contacted through registered mail.
NB No official standardized process. Approach for management of a participant’s follow-up care after an abnormal result varies by site.

Participants are encouraged to register with NB Health Link program to assist with accessing PCP services.

 No official process. Approach varies by site.
NS In the event of an abnormal screening report, the program works with the coordinator of each screening site to get a local PCP to accept the report.

In the event of an abnormal screening report, the breast imaging sites in NS have different processes for unattached patients to: obtain their breast imaging results, be notified of follow-up procedure appointments and to obtain those results, be notified of core biopsy appointments and to obtain those results, and be referred to surgery.

 Central booking site will call the participant. If not successful, central booking staff will contact the PCP to obtain participant’s current contact info.
PE Provincial coordinator (designate) or surgeon contacts the participant about follow-up. Follow-up with phone call to PCP.
NL Program screens participants without a PCP. Medical director and Cancer Screening Pathway Coordinator work with individual to ensure follow-up is complete. Cancer screening is proposing the hiring of a nurse practitioner to assist clients without a PCP. Check alternate source for address. If more recent address is found, letter is re-sent. Otherwise, follow-up with PCP.

*ON: Starting in fall 2024, the Ontario Breast Screening Program will be expanded to include people ages 40 to 49. Until the expansion goes live, people ages 40-49 are able to access breast cancer screening outside of the OBSP with a referral from a healthcare provider.

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